THE DREAD DISEASE Cancer and Modern American Culture By James T. Patterson Harvard University Press. 380 pp. $25.95

SIX DECADES ago Matthew Neely, senator from West Virginia, rose to address his colleagues. "I propose," he said, "to speak of a monster that is more insatiable than the guillotine; more destructive to life and health than the mightiest army that has ever marched to battle; more terrifying than any scourge that has ever threatened the existence of the human race. . . . The sighs and sobs and shrieks that it has exhorted from perishing humanity would, if they were tangible things, make a mountain. The tears that it has wrung from weeping women's eyes would make an ocean. The blood that it has shed would redden every wave that rolls on every sea. The name of this loathsome, deadly and insatiate monster is 'cancer.' "

The senator's rhetoric may now seem overblown and antiquated, but it was typical of its time and, more to the point at hand, typical of the excess with which the subject of cancer has always been addressed. As James Patterson argues in this interesting cultural and social history of the disease in the United States, "dread and revulsion" are the most common popular attitudes toward cancer, with the result that we tend to exaggerate when we speak or write about it. Even though medical science has made progress in identifying the nature and causes of cancer, it remains in the popular mind "obscure in origin and progression . . . as all-embracing and as uncontrollable as other broad and impersonal forces." Even now it is "a stigmatizing illness," or, as one cancer patient put it, "the modern-day leprosy"; small wonder that the rhetoric of cancer is inflated, or that the disease is frequently employed as a metaphor for anything that appears to be uncontrollable, destructive and malevolent.

If anything, what is remarkable is how little our attitudes toward cancer have altered over the years. Though a degree of control is now exercised over certain forms of the disease, most notably those to which children are especially susceptible, and though surgical procedures have greatly improved survival rates in many others, we still view it much as we did in the 19th century, as an indiscriminate killer that strikes without warning and that is caused by mysterious forces beyond our control. Furthermore, the persistence of cancer in the age of science is widely seen as a rude repudiation of the increased life expectancy we have come to regard as our birthright. As Patterson puts it:

"The denial of death was especially strong in the United States, land of perceived opportunity, technological progress and economic growth. It manifested a distinctively American quest for good health, which became central to the good life. It helped account for many responses to cancer in the United States during the 20th century, including a readiness to entertain promises of 'magic bullets' and to spare no financial resources in the attempt to find a cure. In no other nation have cancerphobia and 'wars' against cancer been more pronounced than in the United States."

The formal "wars" have been fought by the "Cancer Establishment," that consortium of public and private groups having at its vanguard the National Cancer Society and the National Cancer Institute; the informal ones have been waged by an assortment of quacks and opportunists whose miracle cures have been eagerly patronized by the desperately ill. The former represents our faith in science, technology and, more specifically, the medical profession; the latter represents our lingering doubts about science and medicine and our susceptibility to superstition. Though the scientists obviously have conducted a more successful "war" than the quacks, their failure thus far to find a remedy as conclusive as those discovered for tuberculosis and polio has left an opening that the peddlers of krebiozen, laetrile and other "magic bullets" have happily exploited.

Then too there is the complicating question of smoking, which as one cancer researcher has said "is almost as if Western society had set out to conduct a vast and fairly well controlled experiment in carcinogenesis bringing about several million deaths and using their own people as experimental animals." Why is it that nearly one-third of adult Americans persist in a habit "that substantially increased their risk of premature death" at a time when the scientific evidence of its toxicity is so conclusive? Patterson weighs the question judiciously, and concludes that the smoking controversy is not merely "a particularly fierce conflict between health professionals and well-organized special interests," but more: "a conflict of cultural values, a conflict between the urgent pursuit of good health and the desire to pursue that goal on one's own terms, and to enjoy the daily pleasures of life in the process."

Many who find smoking to be precisely such a pleasure are members of what Patterson calls "a vast and amorphous cancer counterculture," the predominant characteristic of which is a deep skepticism about medical and scientific orthodoxy. The counterculture has flourished, he believes, because "the various and unorganized critics of the 'Cancer Establishment' offered resistance -- often bitter, harsh and ideologically reactionary -- to the pressures of modernity, liberalism, governmental intrusion, laboratory science and secular thought." Yet Patterson does not dismiss the counterculture as mere ignorance run amok; he recognizes that there are legitimate as well as fanciful reasons for skepticism about the claims of the cancer professionals, that cancer research has followed a persistent pattern of "raising and then dashing the hopes of patients and their relatives."

HE ALSO IS quick to point out that by no means is the cancer counterculture populated solely by fundamentalists and reactionaries. The fear that "everything gives you cancer" is in large measure the creation of environmental extremists, whose "profound unease about technology, industrialization and urbanization" made them "a major source of the diffuse yet unprecedentedly vocal antiestablishment rebellion, one in which otherwise very different groups, such as defenders of laetrile, participated at the same time." The environmentalists were "as tiresome and puritanical as the various regulatory 'experts' who presumed to indoctrinate the public," but their contribution to cancerphobia cannot be underestimated.

Patterson writes about all this gruesome business with clarity and dispassion. He clearly has little patience for the quacks, but neither is he an apologist for the researchers who, having extorted vast amounts of public and private money with their promises of scientific cures, have yet to produce anything even approximating a "magic bullet." The "mystery and power of cancer" remain unsolved and unchecked, "steady reminders of mortality" and the unpredictability of its arrival in each individual's life. Perhaps someday cancer will indeed be cured, but that will merely delay death; nothing can prevent it. ::